Dry Socket: What It Is And How to Heal

Dry sockets are common after wisdom teeth surgery. Here is how to know if you have a dry socket and how to heal it and get out of pain.

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Having your tooth (or wisdom teeth) removed isn’t exactly the most pleasant, but it’s a whole lot worse when you get a dry socket.

Though rare, dry socket is a possible side effect of tooth extraction and wisdom tooth surgery that occurs when the site doesn’t heal properly.

In many cases, patients who have post-surgery complications are unsure whether they’re experiencing dry socket. If they are, they’re even less sure how to heal it.

Take this reader, for example:

“My daughter had her wisdom teeth removed and a week later, she can feel air going inside one socket. In another socket, pus is coming out. I took her back to the dentist two times and he didn’t do anything but rinse it. She is in so much pain and over the counter meds are not working. Another dentist gave her antibiotics for an infection. Should there be cause for concern about these two sockets?”

Her description certainly sounds like a case of dry socket.

But how can she be sure, exactly? And how can you tell if you’ve developed one?

This article will explain what dry socket is and how to heal quickly if you do have one. Additionally, I’ll explain the most common causes of dry socket so you can prevent it and stay complication-free after your wisdom tooth removal surgery.

What is a dry socket?

When a tooth is extracted from the jawbone, a blood clot forms in the empty hole left behind.

Removal of the tooth leaves an empty hole in the jawbone that quickly fills with blood, forming blood clot within the first 24 hours.

The blood clot has two functions: It stops the area from bleeding and, over time, stimulates and facilitates bone healing. Remove that blood clot too soon—before the bone has healed—and you get a dry socket.

Sometimes, the blood clot is jostled free within the first few hours or days following extraction.

This can be a result of vigorous exercise, sucking through a straw, or other activities I discuss in more detail below.

But no matter the cause, without the blood clot present, the bone is fully exposed. This exposure causes intense pain that radiates up and down the face, as well as pain upon drinking cold water or breathing in cold air.

Why does a dry socket hurt so much?

Exposing the bone at the extraction site exposes the pain receptors in the jawbone to the outside world. And pain receptors in bones are some of the most alarmist of nerve pain receptors.

This just means that they hurt. A lot.

Think of the blood clot as a scab on a deep cut on your skin. If the scab comes off too early, the area is exposed and can be extremely painful. It’s also more susceptible to infection.

For these reasons, It’s imperative to keep the blood clot in the socket until the bone has a chance to fill the empty socket and heal. Without the blood clot, the socket will take longer to get better and will cause a lot of pain until the tooth extraction healing is complete.

How common is dry socket?

Dry socket statistics vary by the type of extraction and where your extraction site is. Here are the basics: (1)

Dry sockets happen about 4 percent of the time across all types of extractions.

Extraction of a bottom tooth is 10 times more likely to result in a dry socket than a top tooth.

The mandibular 3rd molars (the furthest back wisdom teeth) develop dry sockets up to 45 percent of the time.

Patients between 40-45 years old are most likely to have a dry socket.

Is dry socket dangerous?

It’s not a life-threatening condition, but a dry socket can cause severe pain and sometimes lead to infection.

Untreated, early dry socket might cause infections that cause abscess or other infection-related symptoms like fever.

There are no known cases of death from dry socket or the subsequent infections.

(Ready to know what to do about your dry socket? Skip down to “What To Do If You Have a Dry Socket.”)

When can you get a dry socket?

You can get a dry socket after a tooth extraction or wisdom tooth surgery. It’s caused by the resultant blood clot being dislodged before the bone and tissue underneath have healed.

Dry sockets are most common between two and three days after surgery.

What are early symptoms of dry socket?

Very fast onset dry socket may result in some bleeding beyond what you should expect within the first 24 hours, as well as severe inflammatory pain in your socket and into the bone. The earlier the clot falls out, the more pain you’ll experience—and the more likely you’ll need a dentist’s help.

After the fourth day, you shouldn’t need to worry about getting a dry socket, because the blood clot will have had enough time to establish itself.

However, every case is different, so I encourage you to talk to your dentist about your particular case and follow the instructions for care provided to you after extraction.

What causes a dry socket?

These are the most common risk factors that may increase your likelihood of getting a dry socket: (1, 2)

Smoking after tooth extraction

Being on birth control

Being a woman, especially if you take a contraceptive, as estrogen may cause the blood clot to dissolve

Tissue trauma during the extraction

Poor oral hygiene or underlying gum disease

Dry sockets in the past

After a tooth extraction, your dentist is likely to advise you against the following:

Drinking from a straw, smoking, or any sort of similar sucking action

Exercise

Coughing and sneezing

Swishing with water

Drinking carbonated beverages (soda, beer, sparkling water, etc.)

These recommendations are made because the pressure from spitting, sucking, swishing liquids, and even sneezing can dislodge the clot.

Tobacco may contaminate the extraction site and/or slow healing. The bubbles in soda and other carbonated beverages can cause the clot to loosen and fall out prematurely.

Additionally, strenuous exercise can raise your blood pressure and make it difficult for the new blood clot to stay in place.

Essentially, you want to be very gentle with your mouth to allow your bone and other tissues ample time to recover under the clot.

Dry Socket Symptoms: How to know if you have one

What does dry socket feel like? If you have dry socket, you’ll have moderate-to-severe pain that extends into the jaw and may radiate out.

Pain is the most obvious symptom of a dry socket.

The best differentiator between normal tooth extraction pain and dry socket pain is timing.

Post-extraction pain peaks and wanes within a 24 hour period. But dry socket pain peaks three to five days after the extraction and will take weeks to go away unless treated by a professional.

It’s also typically more severe and can radiate into the ear, especially when the area is touched with cool water or air. That’s why dry socket can sometimes cause headaches and dizziness.

If you’re experiencing severe pain or bleeding four or more hours after a tooth has been extracted and you’re wondering if you have dry socket, contact your dentist immediately.

Other dry socket symptoms include:

Bad breath

An unpleasant taste in the mouth

Headaches

Dizziness

Insomnia

Fever (rarely, accompanies some infections)

In rare cases, dry socket leading to infection can end up causing trismus, also known as “lockjaw.” This would happen between 10-40 days following the loss of your blood clot.

What does a dry socket look like?

Rather than a dark blood clot, a dry socket appears to just be a hole with white-ish bone at the bottom, or there may be an ever-so-slight tissue covering.

Colors of material over the bone in a dry socket will differ between the types of dry socket you might have, ranging from grayish-green to yellow to a darker red.

If you search for “dry socket pictures,” be aware that these aren’t for those with weak stomachs. This condition is visibly painful.

What To Do If You Have a Dry Socket

I’ve said it once, and I’ll say it again:

If you have any concern that you have a dry socket, see your dentist immediately.

If you do have a dry socket, your dentist will clean the socket and then pack it with a special material that will help ease discomfort and mimic the function of the clot that has fallen out.

The dressing may need to be changed several times while the extraction site heals—typically every 24 to 48 hours for three to six days.

There are two ways your dentist or oral surgeon can pack the dry socket:

Dry socket paste

Pros: relieves pain on the spot

Cons: only a short-term solution

Bone graft material or surgical foam

Pros: More of a long-term solution, useful in cases where bone has thinned and needs a longer time to heal and grow in

Cons: More expensive

Can a dry socket go away on its own?

Depending on when the clot comes out, some cases of dry socket may heal on their own. If you developed the condition on the third or fourth day after tooth extraction, the pain probably won’t last for more than a week and will go away without treatment.

However, a clot falling out on the first or second day after your procedure might require more serious dry socket treatment.

Most cases of dry socket typically heal between 7-10 days after they happen, with untreated, severe dry socket causing potential pain for up to 2-3 weeks.

How To Reduce Dry Socket Pain: Dry Socket Treatment

Over-the-counter NSAIDs, like ibuprofen or acetaminophen, can be helpful in reducing dry socket pain. If they’re not, your dentist may prescribe something stronger.

Keep in mind, these medications aren’t how to treat dry socket, just a way to keep the pain at bay.

S/he may also prescribe antibiotics to prevent infection. If you already show signs of an infection from your open dry socket, this prescription will be very important for preventing more serious issues down the road (like lockjaw).

In addition to medications, there are a few things you can do at home to alleviate the pain of a dry socket.

It’s important to note that the pain of a dry socket is not the same as pain in your gum tissue or tooth enamel. Analgesics (pain-relieving agents) like Orajel are unlikely to provide much, if any, relief.

1. Swish with Warm Salt Water

Gently swishing warm salt water can help to cleanse the exposed extraction site and reduce bacteria. Aim for ½ a teaspoon of Himalayan or real sea salt per 8 oz of water.

I mentioned previously that strong swishing motions can actually cause dry socket, and they can certainly slow the healing process even after dry socket has been diagnosed.

For this reason, I recommend very gentle swishing—or not swishing at all. Just letting the warm water flood the affected area and holding it there can be helpful.

2. Dress with Honey

Honey has been used as a treatment for wounds for hundreds of years.

A 2014 study found also that dressing a dry socket in honey helped with inflammation and reduced pain in patients while causing no side effects. (3)

To try this remedy, place honey on a sterile gauze, and then place it against the dry socket. If you’re using it consistently, be sure to replace it with fresh honey and sterile gauze every three hours or so.

3. Try a Cold Compress

Pressing a cold towel or compress against your cheek near the dry socket can be soothing. Just be sure not to hold ice directly against the skin, or you may get frostbite.

What are the different types of dry sockets?

There are several medical terms your dentist or oral surgeon may use to define your dry socket. The terms refer to different onset and symptoms.

In general, a dry socket is one condition with various complications. There are different terms that define the specifics of the “complications” of a dry socket.

You’ll notice the term “osteitis” used in several of the names listed below. This term refers to inflammation of the bone.

Alveolar Osteitis: This is the basic term for dry socket. It simply means inflammation of the bones that hold your teeth. Other terms for basic dry socket are: (1)

Localized osteitis

Alveolitis

Alveolitis sicca dolorosa

Septic socket

Necrotic socket

Localized osteomyelitis of the mandible

Fibrinolytic alveolitis

Alveolitis simplex

A basic dry socket may leave bone exposed to the naked eye or look dark. It causes intense pain that doesn’t stop and may radiate throughout that side of the face. Fever and enlarged lymph nodes are rare but known symptoms of dry socket.

Superficial Alveolitis Marginal: SAM is classified by the covering of bone tissue in dry socket with inflamed tissue called a granuloma (inflamed grouping of tissue your body can’t get rid of). SAM makes it painful to chew.

Suppurative Alveolitis: This more serious issue is actually similar to dry socket but does not involve the clot falling out of your tooth’s socket. Instead, the blood clot gets inflamed from bone fragments or bone lesions called “osseus sequestrum.”

In suppurative alveolitis, the bone becomes inflamed because of the inflamed blood clot. Your oral surgeon would recognize this because the clot develops a membrane on top that turns grayish-green.

The pain of suppurative alveolitis is medium, as dry socket pain goes. You’re also more likely to get a fever with this form of dry socket. (4)

Final Thoughts On Dry Sockets

A dry socket is a rare, but very painful, complication that can follow tooth extraction. The good news is that it’s also highly treatable, should it occur.

Following your dentist’s recommendations after extraction can go a long way in preventing dry socket. If you’re experiencing severe pain 24 hours post-extraction, contact your dentist immediately to seek his expertise.

The longer you can go without a clot falling out, the better. A dry socket within the first day will probably require dental assistance, while a clot coming out between days three and four may not be as painful and may be treated safely at home.

If you have a dry socket, you can try these remedies to improve the pain:

Swish with warm salt water

Dress with honey

Try a cold compress

Apply essential oils

Drink anti-inflammatory teas

Take over-the-counter NSAIDs (or doctor-prescribed pain relievers)

Preventing a dry socket will always be the best option. After a tooth extraction or wisdom tooth surgery, avoid any sucking motions and be very gentle with your mouth and body.

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